Healthcare Provider Details

I. General information

NPI: 1821810722
Provider Name (Legal Business Name): SARA BOZARTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARA NEWSOM

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6120 NE 12TH AVE APT 102
PLEASANT HILL IA
50327-8802
US

IV. Provider business mailing address

3015 NE 52ND CT
DES MOINES IA
50317-4915
US

V. Phone/Fax

Practice location:
  • Phone: 515-720-6455
  • Fax:
Mailing address:
  • Phone: 515-650-0898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberX000913411
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: